Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01892 | Date 08/04/2019 |
| Token No | SM/18-19/3120 08/04/2019 | Serial | 001 |
| Patient Name | Miss LAXMI SHA | Contact No | NOT GIVEN |
| Address | 8 NO DEY STREET | Age | 26 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||